<b>CT Evaluation of the Response of Gastrointestinal Stromal Tumors After Imatinib Mesylate Treatment:</b> A Quantitative Analysis Correlated with FDG PET Findings

Germ-line mutations in the KIT receptor tyrosine kinase gene have been described in families with a propensity to develop gastrointestinal stromal tumor (GIST). There is limited information from large kindreds regarding median age at diagnosis, detailed histopathology, clinical effects of imatinib therapy and chromosomal abnormalities of the KIT gene. We identified a large kindred with GIST. Each family member was interviewed and appropriate medical records and radiographic imaging were obtained. Archival tumor tissue was obtained to confirm diagnosis, extract genomic DNA and perform fluorescent in situ hybridization cytogenetics of the KIT gene. Fifteen of 79 individuals with GIST were identified in this kindred. There were 8 males, the mean age at diagnosis was 53.9 (range 45-71) years. Histopathology revealed microscopic proliferation and nodularity in the myenteric plexus, spindled morphology, diffuse Kit but variable CD34 staining and low mitotic rates in the setting of metastatic disease. A deletion of codon 579 in exon 11 of the KIT gene was identified in tumor and normal tissue of this family. Mutation and cytogenetic analysis revealed homozygous loss of the wild-type KIT sequence in tumor from one individual. Four of 4 individuals treated with imatinib are alive and without progression while 9 of 11 individuals not treated with imatinib are deceased. This study describes a kindred with a propensity to develop GIST in an autosomal dominant pattern. Germ-line deletion of KIT codon 579 in GIST is associated with clinical benefit from imatinib, limited utility of mitoses to predict malignant potential, and a novel homozygous deletion of this codon in one individual. ' 2007 Wiley-Liss, Inc.

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“…5c and 5d). 22,23 This is the first report to describe in vivo radiographic evidence efficacy of imatinib in patients from a GIST prone kindred.…”

Section: Imatinib Therapy Of Individuals From a Gist-prone Kindredmentioning

confidence: 89%

Clinical, histopathologic, molecular and therapeutic findings in a large kindred with gastrointestinal stromal tumor

Kleinbaum

Lazar

Tamborini

et al. 2007

Intl Journal of Cancer

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“…Measuring tumor diameter in one dimension is inappropriate in some solid neoplasms, such as peripherally growing tumors like malignant pleural mesothelioma 9, 10. Changes in tumor size do not reflect changes in tumor biology and anatomic changes will occur more slowly than functional changes within a tumor, for example, in gastrointestinal stromal tumors treated with imatinib 11. Furthermore, tumor cavitation and changes in density are signs of a response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Significance of different response evaluation criteria in predicting progression‐free survival of lung cancer with certain imaging characteristics

et al. 2016

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BackgroundCertain radiographic signs of a treatment response, such as cavitation, changes in density, or tumor change along a short axis, are not considered by Response Evaluation Criteria in Solid Tumors (RECIST). This study evaluates what additional prognostic information can be obtained by including these criteria in tumor assessment.MethodsData of 105 patients were included. Tumor cavitation was observed in 51 patients at baseline. An additional 23 patients developed tumor cavitation during treatment. A change in tumor density was the only radiographic treatment response observed in 22 patients. The only measureable treatment response in nine patients was a decrease along the short axis size of the tumor. Tumor response was assessed using various criteria.ResultsIn patients with basic tumor cavitation, RECIST1.1 scores accurately predicted differences in progression‐free survival (PFS; P = 0.076) while modified (m) RECIST did not (P = 0.550). mRECIST detected a significant difference between PFS in patients with post‐therapeutic cavitation with different responses, but no significant difference using RECIST1.1 (P = 0.004 vs. P = 0.477). In patients with only tumor density changes, there was no significant difference in PFS when either RECIST1.1 or density criteria were used (P = 0.419). In patients with a change in size along the tumor's short axis, short axis criteria could predict significant difference in PFS (P = 0.004).Conclusions RECIST1.1 provides the best assessment of tumor response and prediction of PFS in patients with basic tumor cavitation. mRECIST provides better PFS prognostic information in patients with post‐therapeutic cavitation. Short axis criteria provides better PFS prognostic information in patients with changes in the short axis of tumor diameter. Changes in tumor density were not a useful prognostic sign.

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“…Consequently, in addition to tumor size, the criteria take into account the tumor's density in CT (venous phase) [26] ( • " Table 2). …”

Section: Gastrointestinal Stroma Tumor (Gist): Choi Criteriamentioning

confidence: 99%

Radiological Evaluation of the Therapeutic Response of Malignant Diseases: Status Quo, Innovative Developments and Requirements for Radiology

Höink¹,

Heindel²,

Buerke³

2014

Fortschr Röntgenstr

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!In consequence of the rapid development of newer targeted and personalized tumor therapies, radiology as an essential component of the treatment concept of numerous malignant diseases needs to improve in order to adequately capture and evaluate the effects, but also the side effects of these novel therapeutic agents. The early recognition of therapy response or failure is crucial for the optimal planning of the further treatment and can therefore have direct impact on the chances of recovery and the survival time of oncological patients. In previous years, the goal of medical imaging was to just qualitatively assess the increase or reduction in the size of tumors and their metastases, which was often achieved by a simple subjective estimation of the tumor findings by the diagnosing radiologist. Nowadays, radiology is faced with the challenge of evaluating changes during therapy quantitatively and of visualizing therapeutic effects that are more discrete (e. g. necrosis, altered tumor perfusion). The importance of an adequate assessment of therapy response is further underlined by the fact that in these days, a good portion of oncological patients are enrolled in clinical trials, in which the quantitative radiological evaluation of malignant disorders is an important surrogate parameter. On the basis of this development, the demands for radiology to provide more sophisticated assessments of therapy response and documentation of imaging findings have been constantly growing.The following article provides an overview of the established and still widely spread but in particular also the latest imaging modalities and evaluation criteria with regard to oncological diseases as well as of the increasing demands on radiology that result from these developments. Beyond that, future advancements in tumor imaging are taken into account and the new challenges these developments will bring are discussed.

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CT Evaluation of the Response of Gastrointestinal Stromal Tumors After Imatinib Mesylate Treatment: A Quantitative Analysis Correlated with FDG PET Findings

Cited by 427 publications

References 14 publications

Clinical, histopathologic, molecular and therapeutic findings in a large kindred with gastrointestinal stromal tumor

Clinical, histopathologic, molecular and therapeutic findings in a large kindred with gastrointestinal stromal tumor

Significance of different response evaluation criteria in predicting progression‐free survival of lung cancer with certain imaging characteristics

Radiological Evaluation of the Therapeutic Response of Malignant Diseases: Status Quo, Innovative Developments and Requirements for Radiology

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